The need for Personal Protective Equipment for health care workers and its availability
While battling COVID-19; it is vital for healthcare workers to use appropriate Personal Protective Equipment (PPE) to protect themselves from hospital acquired infections. On 15th May 2020; our Ministry of Health and Family Welfare issued revised guidelines for rational use of PPE for healthcare workers in non-COVID areas of hospitals. Between 01st March 2020 to 18th May 2020, our PPE industry witnessed 56 times growth; moving from zero, to production of nearly 4.5 lakh PPE kits every day (Fig. 1).
Figure 1. PPE industry in India has witnessed 56 times growth in 60 days
It is undoubtedly of paramount importance to safeguard all our healthcare workers from COVID-19. But it has been observed that many times; citizens at large; use PPE like disposable N95 respirators and disposable nitrile gloves; which are actually meant for healthcare workers working in COVID and non-COVID areas of our healthcare facilities. Thus, while there may now not be a scarcity of PPE; an important aspect that is likely to get neglected is an enormous amount of plastic waste that is being generated.
Biomedical waste produced in healthcare facilities during the Covid-19 Pandemic:
A comparison of the biomedical waste generated only in healthcare facilities; i.e. isolation wards, institutional quarantine centres, sample collection centres and laboratories; in different time frames in a single state i.e. Punjab; shows a total of 72,194 kg collected in 53 days between 25-03-2020 and 17-05-2020; increased to 27,083 kg in only 14 days between 18-05-2020 and 31-05-2020; which further increased to 81,400 kg in the 30 days of June 2020. In the city on Mumbai; in March, bio-medical waste collected from COVID Care centres and hospitals, was 3.48 lakh kg bio-medical waste generated with an average of 11,230 kg daily. While in April it was 12,675 kg, in May it increased to 17,631 kg and June saw the biggest jump with 22,023 kg daily. Until July 15, the daily average fell to 13,725 kg which was 38% below the average of bio-waste collected in June. In July, BMC has collected a total of 6.60 lakh kg of bio-medical waste.
Biomedical waste produced in our homes during the Covid-19 Pandemic:
In these testing pandemic times, generation of biomedical waste may not be limited to healthcare facilities alone; but may also; most likely be added upon by households due to use of disposable PPE like single use disposable face masks, N95 respirators and gloves; followed by their inappropriate disposal i.e. disposal without waste segregation into household and medical waste. (Fig. 2).
Figure 2. Household waste disposed showing food waste mixed with other household waste and also the disposable face masks being segregated by a stick
The onus of segregation of such waste and the risk of infection from such waste then comes upon the Safai Sevaks i.e. waste collection personnel (Fig. 3); and if this is not done; such waste degrades or breaks down into smaller sized particles (under 5 mm) i.e. microplastics; and then get environmental access; by inappropriate disposal in landfill, dump sites, fresh water, oceans or plainly through littering at public spaces; causing environmental imbalance.
Figure 3. A Safai Sevak in Mumbai after having segregated biomedical waste – in this picture disposable masks from other household waste
Responsibility of citizens related to biomedical waste during the Covid-19 Pandemic – Simple Solutions:
The onus is then on us citizens to appropriately dispose single use disposable face masks, N95 respirators and gloves. These can be wrapped in newspapers or paper bags and marked as biomedical waste with a red highlighter before disposal; so that the waste segregation personnel would easily spot such waste and appropriately segregate them easily. Further, while the healthcare workers use their PPE judiciously; it may be important that those of us who are not health care workers; should not resort to using PPE meant for healthcare workers; like citizens using disposable N95 respirators or even non-judiciously insisting on health-care workers using ‘full PPE’ in non-COVID areas of laboratories or hospitals; when such use is actually not warranted or recommended.
Need for education, awareness and innovations:
It may thus also be pertinent now that healthcare workers working in Covid and non-COVID areas of hospitals; educate and create awareness amongst their patients and general public at large. One such small step could be taken if other-wise healthy patients with non-respiratory symptoms; visiting healthcare facilities wearing N95 respirators; can be made aware of the presence of more cost-effective and environment friendly options like biodegradable engineered filtration layer masks at par with N95 respirators. Such awareness, will not only ensure the availability of PPE to our healthcare workers; but also go a long way in maintaining a vital ecological balance; while balancing the safety needs of our citizens and healthcare workers. Innovations like the one which potentially turns PPE waste into economical bricks are very inspiring in these times and could possibly help solve the problem up to a certain extent. (Fig. 4)
Figure 4. A P-block 2.0 made using 52% of shredded PPE material, 45% paper sludge, and 3% binding agent-formulated gum base.
Conclusion:
In conclusion we reiterate, citizens using reusable and bio-degradable masks which can be washed and reused shall help to limit wastage. There is a need for disposing of waste from single-use Personal Protective Equipment generated at the household level with utmost care possibly by wrapping the PPE in a newspaper or a paper bag and mentioning medical waste with red coloured highlighter which could help in segregation and also limit the infection of our Safai Sevaks.
